The Neurocognitive Basis for Learning Disabilities and Executive Function Deficits: A Primer for Parents

To understand the obstacles to students’ learning and performance success, you need not look any further than their processing ability and executive function profiles. The key here is to remember that academic subjects are composed of groups of processing abilities that are, in turn, linked with specific executive functions that serve the purpose of cueing or directing the activation of those abilities in the service of performing a task. For example, the primary processing abilities that are part and parcel of reading include phonemic awareness/auditory processing, orthographic/visual processing, nonverbal reasoning (for inference and comprehension), and long-term memory. The executive functions that support the processing abilities involve activation to work, establishing and sustaining a focus, inhibiting the urge to respond to something other than the reading assignment, adequate processing speed, and shifting to allow movement from one part of the reading assignment to another. Any breakdowns in either the processing skills or executive functions will result in reading difficulties.

The strength of a neurocognitive approach lies in breaking down the primary ability areas further into the narrow abilities that comprise each domain. Here is where the detective work begins. For example, language processing is a primary ability area. It is not sufficient to obtain a score from tests on just this primary ability area because within the domain of language processing there are various narrow skills that may be responsible for students’ difficulties. For instance, lexical knowledge is a narrow ability that encompasses the fund of acquired vocabulary a student has stored in long term memory. It is not uncommon for many students to have average or above average ability in this narrow ability area. Yet, in another narrow ability area, verbal reasoning, which is the skill needed to think and write in a more abstract way, these students falter. Thus, they would do better on vocabulary and spelling tests which rely on rote memory, but struggle when it comes to reading comprehension and making the inferences involved in more conceptual thinking.

Getting to the bottom of students’ learning problems requires this kind of detective work which can be thought of a peeling back the layers of an onion where the starting point are the primary abilities in the top layer and then going further to the layers underneath to get to the narrow ability areas that can be interfering with learning and performance.

Similarly, analyzing the many executive functions-brain processes that cue and direct the activation of the abilities-is of equal importance. For example, there are students whose academic abilities are sound. However, deficits in executive functions like attention, activation to work, or inhibition may leave them adrift, relegated to “spacing/zoning out” and to frequent periods of distractibility, all of which causes them to miss out on instruction. Another common problem occurs when students with an adequate vocabulary are unable to generate an adequate amount of verbiage because of problems with the executive function of planning and organization when faced with demands in producing narrative writing. Thus, these students do not have a learning problem (i.e. a learning disability), but have an executive function deficit (i.e. a producing problem). Writing is a complex skill where executive function deficits in the form of students being unable to get the ideas in their heads onto paper are a common complaint.

The most comprehensive and scientifically valid approach to investigating ability and executive functioning deficits is a neuropsychological evaluation. This kind of assessment not only identifies students’ patterns of strengths and weaknesses, but links these to accommodations and instructional practices that target these specific areas. Generating concrete and practical strategies that target a students’ weaknesses offer teachers, parents, and tutors with the most effective ways to address learning and performance problems.

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When Students Don’t “Get It”: Is it Auditory Processing Speed, Listening Comprehension, or Slow Retrieval?

Students who are unable to keep up with orally presented information are often experiencing problems with auditory processing speed. This may be manifested by difficulties simultanenously listening and taking notes, not remembering multi-step directions, needing information to be repeated, and, at times, asking questions or making comments that may have nothing to do with what is being discussed or presented. They often present with a “deer-in-the-headlight” look. That is, information is passing them by much more quickly than they can process it.

Sometimes slow auditory processing speed is accompanied by deficits in listening comprehension or receptive language so that they are unable to comprehend what is being discussed. This kind of problem is often due to a weakness in the amount of vocabulary and overall language that has been acquired so that students actually do not understand the language itself. Weak vocabulary is a common consequence with students who have difficulty reading or do not like to read, diminishing the amount of vocabulary they have encoded.

Another variation are students who may have acquired an adequate store of language, but have very slow retrieval speed. Consequently, they cannot recall vocabulary definitions or verbiage quickly enough from long term memory to process orally presented information efficiently.

The best way to understand which of the above (or what combination of processing deficits) are implicated is to conduct a comprehensive neuropsychological evaluation. This type of evaluation can differentiate between problems with auditory processing speed, receptive language deficits, and slow retrieval of information from long term memory. Once the problem is understood, accommodations and instructional strategies can be prescribed.

Some possible accommodations and instructional strategies for slow auditory processing speed are to slow down the presentation of information and/or present it in smaller segments. This may be accompanied by the use of visuals like graphic organizers to use a multi-sensory approach. Notes can be supplied and a smart pen may be used to capture information that may be transcribed to a computer.  Having students repeat information to make sure they “got it” can also help as well as giving directions in short, concise statements without adding any excessive language to process. Using a cloze procedure may also help to jog long term memory.

Listening comprehension problems have to do with understanding language and in some cases supports may be added to build vocabulary and apply it in oral and written expression.

It is most important not give students with these deficits the feeling that they are not smart. Teachers and parents need to regulate their emotional responses when their students do not get it or make responses that are out of context. This is hurtful and damaging. Instead, consider investigating the source of these types of responses with an open mind without rushing to judgment. There are always strategies to help.

The Importance of Differentiating Instruction for Success

Differentiating instruction may be the key to academic success for many students whether they are classified or in the mainstream. The principle behind differentiation is simple: different students process information and learn in different ways and it is important that teachers adapt the content, process or format to match the varying learning styles of their students. For example, some may be visual learners while others do best when material is presented in a verbal format. However, in the fast-paced, curriculum driven atmosphere of education today, there often exists a one size fits all way of presenting instruction and instructional materials. In addition, while lip service is often given to the importance of differentiating, many teachers have not received sufficient training to adequately adapt to the differences in the student body. Moreover, some consider differentiation something you do only for special education students. What about the differences in the wider population of general education students in the mainstream?

Differentiating begins by teachers assessing what each student actually knows about a particular content area. Next, it is of equal of even greater importance to understand how students process information. The example above about verbal vs. visual learners is just one of many different pieces of information that may guide teachers in determining how to present instructional materials. Sometimes the content is varied so that different students have different kinds of tasks to perform within the same academic subject. At other times, the same information is presently differently to different students. Another variable to consider is students’ interests. If teachers know that certain students have specific content area interests or are mobilized by music or movement, then these elements can be built into instruction to capture and maintain students’ motivation.

It is not uncommon for teachers and parents to need to seek out more specialized ways of assessing either student’s depth of acquired knowledge or their individual style of processing information. The most thorough way of accomplishing these tasks is to utilize a comprehensive psycho-educational or neuropsychological evaluation. These types of assessments focus in on measuring students’ knowledge base and information processing skills. Moreover, the results of these evaluations can be directly translated into instructional strategies which teachers and parents can use to give their students the best opportunity for academic success. A good evaluation will provide teachers with information that they may be unable to obtain on their own.

Surviving Your Child’s Academic Struggles: The Value of a Neuropsychological Perspective

One of the most painful and anxiety inducing experiences parents have to endure is when their child is not making it at school. The realization that something is wrong may come about as a result of a call from the teacher or after attempting unsuccessfully to help a child with homework or understanding a concept taught that day at school.

What are parents to do?

First, it is essential to try to contain the worry that is induced by this discovery and even more important to fight the urge to be critical of your student that may result from your well-meaning, but ineffective attempt to help.

Second, it is important to avoid taking steps (i.e. immediately running out and hiring a tutor) without first having some understanding of the specific nature of your child’s problem and what kind of person or professional is the right one to address it. Many tutors are former or current teachers and while they may be competent at teaching a class, they may not have the skills to understand and address your child’s problems. Keep in mind that there is a difference between tutoring to achieve task completion (i.e. homework) and tutoring that addresses the root problem of your child’s difficulties.

What do parents, tutors, and teachers need to know?

-Academic subjects are really just names of groups of abilities that are needed to perform successfully in that subject area. For example, students with reading fluency problems may be experiencing difficulties with auditory/phonological processing, orthographic/visual  processing, long term memory, processing speed, or a combination of the above. WITHOUT KNOWING WHICH UNDERLYING ABILITIES ARE AT FAULT, INTERVENTIONS MAY BE PRESCRIBED THAT DO NOT TARGET THE DEFICITS, PROLONGING THE PAIN AND SUFFERING RESULTING FROM A LACK OF MASTERY OF THE CURRICULUM.

Identifying the root causes of a learning difficulty is best accomplished by a comprehensive neuropsychological evaluation. A competent assessment will scientifically go through the steps involved in diagnosing the presence of ability deficits and construct a tailor made intervention plan to address the problems. This includes helping tutors, teachers, and parents with specific ways to individualize instruction to maximize success.

-Identifying the root causes includes not only an analysis of your child’s ability strengths and weaknesses, but also their executive functions. Executive functions are brain processes that direct the brain to engage your child’s abilities in order to meet task demands. For example, children who procrastinate may have a very high threshold of stimulation needed to activate them.

The key here is: understand before doing. It will save time, money, and psychological pain for you and your child.

To learn more about obtaining a neuropsychological understanding of your child’s problem, click here drkorner.com

The Impotence Impasse: Surviving Unmotivated and Disaffected Children

One of the most difficult challenges for parents, teachers, and therapists is dealing with the unresponsiveness if unmotivated or disaffected children. Impasses develop because there is an absence of connectedness between the adults and children.  Despite our best efforts, everything we know or have learned does not effect change. In fact, being stuck often leaves us with a feeling of helplessness, hopelessness, and ineffectiveness.

What is worse is that this impasse deadens us, and it is very difficult to be spontaneously creative or think out of the box. Instead, we experience a feeling of dread when we think of our next encounter with the child or situation that is stumping us, and engage in a kind of predictable “dance” where we repeat the same logical, reasonable strategies that have failed only to feel even more defeated when they fail once again.

Here is what we need to understand about impasses and how to break them:

  • Impasses are bilateral. That is, each party is contributing to the stalemate.
  • Impasses develop as a result of deterioration in the state of the relationship we have with the other party. This worsening of relationships comes from or starts with a withdrawal of emotion or connection.
  • Fixing the connection requires that we find ways to rekindle the good feelings we have had in the past.
  • Paradoxically, the beginning of the solution to the impotence impasse is the willingness to acknowledge our feeling of powerlessness. It is only then that we can unlock its’ inherent power and utilize it as a strategic tool to lift ourselves out of the morass in which we find ourselves.

How does this work? Children who are unhappy, angry, or frustrated with the adults in their lives or with school will tend to induce in adults the very same feelings they are experiencing. They typically do this by being unresponsive (i.e. not answering when contacted, saying “I don’t know” or “I don’t care”) which usually leaves adults with feelings of powerlessness resulting from the disbelief, fear, and rage that may result.

As difficult as this may be, the first thing adults must do to break the impasse is to tolerate the induced feelings and join with the child in their feeling. It is important to remember that this does not mean sanctioning their behavior or accepting it. It simply means that you must start where the child is if you wish to promote a change. For example, an oppositional young girl who was furious about her mother dragging her into therapy, would not talk to the therapist. She even went as far as turning her back to the therapist. The therapist, resonating with the child’s rage, questioned how come her parents have not figured out that she has no intention with cooperating with their plan that she see a therapist? By posing this question, the therapist was putting into words what this girl was acting out and indirectly acknowledging how she was feeling. As a result, the girl began to talk about how her mother does not even know her and the impasse was broken.

Impasses are really resistances on the part of the child who is acting out emotions instead of talking about them. They are also counter resistances-behaviors by adults who are also acting out instead of talking about the feelings induced in them by the child. The end result is that the emotional connection is attenuated and each party just engages in a repetitive behavioral cycle that each knows will go no where.

Tolerating the intolerable feelings and not acting on them is a difficult task. However, it is absolutely necessary in order to break impasses between adults and children. The next step-giving the impasse or resistance a “twist”, is also difficult and requires some expert consultation. Changing a system requires a system. Thus, adults who are stuck in a tug-of-war with the children in their lives may need professional help to turn impasses into constructive relationships.

Executive Function: The Engine that Could

Everyone is talking about executive function or “executive function disorder” these days to try to explain difficulties their child may be having at school or in life. It is not clear, however, that this term is being understood in the same way by parents or teachers. Moreover, there is no such diagnosis. Diagnosis notwithstanding, deficits in executive function can play a significant role in a young person’s development.

Executive function has been likened to an orchestra conductor who, with a wave of the baton, tells the musicians when to play, how loud or soft to play, and when to begin and end. Another way of thinking about executive function is as a group of neuropsychological processes that serve as the engine to drive or regulate an individual’s access to his or her cognitive abilities. Without adequate “torque,” the engine does not drive the car.

An example of this is the intertwined executive functions of activation, attention, and memory. Individuals with high levels of arousal-that is, they need a great deal of stimulation to get activated-will be unable to fully direct their attention to the task at hand. Since attention is the bedrock of learning, there will likely be important information missed. Furthermore, whatever has not been attended to can’t be encoded in memory. Consequently, teachers may complain that students learn something one day, but are unable to remember it the next day. There are other executive function deficits that can explain this common complaint. For instance, some students have very slow retrieval speed. Thus, some have difficulty encoding information while others have trouble retrieving it.

Here is the point: individuals with excellent ability can have problems functioning if their executive functions are not operating efficiently as they will limit access to those abilities.

What is a parent or a teacher to do? Deficits in executive function are frustrating and often feel resistant to remediation. Very often logical and reasonable strategies fail miserably. For instance, there are a myriad number of planning and organization problems students exhibit where they are either having trouble planning how to complete a task and underestimating the time needed or regularly lose important papers or books. Applying logical solutions like organizers and timers or color coded folders work at times, but just as often do not work because they are not utilized correctly or regularly.

Since executive functions are wiring, modifying them requires a good deal of effort to enlist the cooperation of the individual student to battle with wiring issues. First, awareness must be raised because executive functions operate automatically and while disruptive, they have a certain familiarity and are often not dystonic. That is, students may not be as troubled by these issues as adults are. An example of this is telling students who have problems with time that they will earn lower grades, not get into a good college, or try to extoll the virtues of being on time may not register as these students have not developed a good time perspective.

A second step, and one often missed, is to assess a student’s objections to “buying in” to using a strategy. This is essential in order to search out unspoken resistances. Without first understanding these obstacles to successful application of a strategy, students are likely to act out their objections by not being cooperative or compliant. It is only when you understand what prevents reasonable courses of action from working that you can achieve success. Exploring these objections requires patience and a healthy dose of tolerance as the rationales may not be logical. However, this does not make them less potent as forces that can destroy your efforts. Once you unearth these objections, you can find a way to join with students so you are not viewed as an adversary, but, instead, someone who understands them. It is this understanding/joining that builds relationships and leverage. Once this is accomplished, the probability of having strategies “stick” will increase.

Response To the Right Intervention (RTRI): Marrying Neurocognitive Science to RTI

In an excellent chapter, “Linking School Neuropsychological with Response to Intervention Models,” in Best Practices in School Psychology, Della Toffalo (2010) asserts that “…educationally relevant cognitive neuropsychological assessment…can and should occur at any time (any tier) in the RTI process when an intervention team has good reason to believe that standard protocol interventions may not be adequate to address the needs of an at-risk student (p.176).”

What does this mean? When IDEA was revised to include RTI as a way to establish eligibility for special education to correct the flaws of the ability discrepancy approach, it did not go far enough. That is, students who simply fail to be successful after a RTI plan should not be automatically considered to be learning disabled. First, this view of a learning disorder fails to include the universally accepted definition of a learning disability as including a processing deficit. Moreover, it just becomes another wait-to-fail model as students may proceed through tiers of intervention without the process being informed by cognitive processing information that could help in targeting students’ deficits earlier in the intervention process.

To elaborate, it is essential that the intervention team have available all tools that can diagnose students’ learning, behavioral, or emotional difficulties at any time (any tier). Della Toffalo includes a list of disorders involving learning disabilities which RTI alone may not be successful. It just makes no sense not to use all the neuropsychological tools available to identify the source of students’ learning and performance difficulties and to have this information drive the intervention process. Otherwise, the team is in danger of shooting from the hip, a practice that may inevitably lead to the failure of the prescribed interventions.

For example, academic subjects are byproducts of cognitive processing skills. Identifying and isolating those processes that are causing students’ problems can lead to more effective interventions. Does a students’ reading problem stem from a phonological or orthographic processing deficit? Are math problems due to a problem with memorizing basic math operations or the sequential steps to solve a word problem or to conceptual difficulties? This kind of specific knowledge about students’ issues is needed to craft an individually tailored plan. This kind of information can be obtained from the administration of specific subtests from a neuropsychological battery that are targeted to the areas of concern. In addition, this can all be done prior to going through four tiers when a full battery is needed. Of course, if a comprehensive evaluation is needed, it should be considered. However, RTRI can spare students and the intervention team a lot of time, effort, and pain.